Comparison of Serological Response to Doxycycline versus Benzathine Penicillin G in the Treatment of Early Syphilis in HIV-Infected Patients: A Multi-Center Observational Study
Open accessAbstract
BACKGROUND: While doxycycline is recommended as an alternative treatment of syphilis in patients with penicillin allergy or intolerance, clinical studies to compare serological response to doxycycline versus benzathine penicillin in treatment of early syphilis among HIV-infected patients remain sparse. METHODS: We retrospectively reviewed the medical records of HIV-infected patients with early syphilis who received doxycycline 100 mg twice daily for 14 days (doxycycline group) and those who received 1 dose of benzathine penicillin (2.4 million units) (penicillin group) between 2007 and 2013. Serological responses defined as a decline of rapid plasma reagin titer by 4-fold or greater at 6 and 12 months of treatment were compared between the two groups. RESULTS: During the study period, 123 and 271 patients in the doxycycline and penicillin group, respectively, completed 6 months or longer follow-up. Ninety-one and 271 patients in the doxycycline and penicillin group, respectively, completed 12 months or longer follow-up. Clinical characteristics were similar between the two groups, except that, compared with penicillin group, doxycycline group had a lower proportion of patients with secondary syphilis (65.4% versus 41.5%, P<0.0001) and a higher proportion of patients with early latent syphilis (25.3% versus 49.6%, P<0.0001). No statistically significant differences were found in the serological response rates to doxycycline versus benzathine penicillin at 6 months (63.4% versus 72.3%, P = 0.075) and 12 months of treatment (65.9% versus 68.3%, P = 0.681). In multivariate analysis, secondary syphilis, but not treatment regimen, was consistently associated with serological response at 6 and 12 months of follow-up. CONCLUSIONS: The serological response rates to a 14-day course of doxycycline and a single dose of benzathine penicillin were similar in HIV-infected patients with early syphilis at 6 and 12 months of follow-up. Patients with secondary syphilis were more likely to achieve serological response than those with other stages.
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Doxycycline 100 mg once or twice daily for 14 days is effective for syphilis.
“although 100 mg once (OD) or twice daily (BD) for 14 days is effective,92–96”
From BASHH UK guidelines for the management of syphilis 2024 (2024) · cites this paper as [94]
The Abstract Methods and Discussion report that doxycycline 100 mg twice daily for 14 days produced a serological response in HIV-infected patients with early syphilis. The paper does not assess once-daily dosing, and its findings do not establish effectiveness for syphilis generally. (LLM, conf=0.90)
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- Authors
- Tsai, J.-C., Lin, Y.-H., Lu, P.-L., Shen, N.-J., Yang, C.-J., Lee, N.-Y., Tang, H.-J., Liu, Y.-M., Huang, W.-C., Lee, C.-H., Ko, W.-C., Chen, Y.-H., Lin, H.-H., Chen, T.-C., & Hung, C.-C.
- Affiliations
- National Taiwan University (TW)
- Taichung Veterans General Hospital (TW)
- Kaohsiung Medical University (TW)
- Far Eastern Memorial Hospital (TW)
- National Cheng Kung University Hospital (TW)
- Chi Mei Medical Center (TW)
- Changhua Christian Hospital (TW)
- Chang Gung University (TW)
- E-Da Hospital (TW)
- Corresponding author
- Chen, Tun-Chieh
- Hung, Chien-Ching
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-10-13
- Volume
- 9
- Issue
- 10
- Pages
- e109813
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4195693
- OpenAlex
- W1970411465
- Cited by
- 49
- References
- 30
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 7 · 2021: 2 · 2020: 8 · 2019: 6 · 2018: 4 · 2017: 5 · 2016: 2 · 2015: 4 · 2014: 1
- FWCI
- 2.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Centers for Disease Control and Prevention (DOH102-DC-1401)
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Historical Medical Research and Treatments
- Life Sciences › Immunology and Microbiology › Parasitology › Vector-borne infectious diseases
- Keywords
- early syphilis, HIV coinfection, doxycycline, benzathine penicillin G, serological response, RPR titer, secondary syphilis, early latent syphilis, syphilis treatment, penicillin allergy, antibiotic comparison, medication adherence
- MeSH terms
- Adult, Doxycycline, Follow-Up Studies, Humans, Male, Middle Aged, Penicillin G Benzathine, Syphilis, Syphilis Serodiagnosis, HIV Infections, Multivariate Analysis, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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